Controlateral Mandibular Metastasis of Follicular Variant of Papillary Thyroid Carcinoma

  • Background/Purpose
    Thyroid cancer is the most common endocrine malignancy. Approximately 90% of thyroid cancer are well differentiated, with 10-year overall survival rate of 90% and rare distant metastasis.

    Methods
    A 69-year-old female was evaluated for a 5 cm swelling of the right parotid region fixed to the ramus of the mandible. FNAC was positive for metastatic thyroid tissue and CT  showed an osteolytic lesion of the right mandible and a 4 cm suspect nodule within the right thyroid lobe. A PET-18FDG scan revealed a 2 cm nodule of the left hemithyroid with increased uptake compared to the right nodule.A stepwise approach with total thyroidectomy and then metastasis excision was adopted. 169 mCi radioactive iodine therapy was performed.

    Results
    Histology confirmed the presence of a follicular variant of papillary thyroid carcinoma of the left lobe with contralateral jaw metastasis. No recurrence occurred during follow-up.

    Discussion
    The incidence of distant metastasis at presentation in DTC is 1-4%. The jaws and mouth represent uncommon sites for metastatic localization, and thyroid malignancies cause the 2% of facial skeleton metastasis and about the 4-6% of jaw metastases. 5-years-disease specific survivalS in patient with distant metastases is about 43-60%, and there is evidence proving that surgical resection of  bone metastases along with total thyroidectomy may provide better survival by increasing the effectiveness of radio-iodine therapy.

    Conclusion
    Despite its rarity, here we present the case of a contralateral jaw metastasis of thyroid differentiated carcinoma.

 

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